In certain patient care situations, a first responder must immediately establish and maintain a patient's airway. Once an airway is established, the first responder must determine whether the patient is breathing. If breathing is adequate, maintenance of the airway should be continued. If breathing is inadequate, or absent, artificial respiration should be initiated.
Depending on among other things, the type and extent of an injury, various procedures and devices are available to assist in establishing an airway. Relatively less intrusive techniques for establishing an airway typically used in the absence of trauma include the head-tilt/chin-lift maneuver. With suspected trauma and/or an unconscious patient, a modified jaw thrust technique may be more appropriate to open the airway. Other methods for establishing an airway include the insertion of a nasopharayngeal airway, or in the case of a potentially life-threatening situation such as a complete upper airway obstruction the patient may require a tracheotomy or cricothyrotomy.
In this regard, a tracheotomy is generally defined as a temporary or permanent treatment for a variety of causes of breathing difficulties in which the creation of a new breathing pathway is required to by-pass the nose, mouth, and upper throat. A tracheotomy is usually considered when an endotracheal (ET) tube (a tube that goes in the throat through the mouth) will not be effective (in some emergency situations for example), or would be required for a long time. Sometimes, a tracheotomy is performed when an ET tube cannot be placed due to narrowing of the windpipe, blockage of the voice box (larynx) or facial trauma prevents intubation via the ET tube.
When an airway must be created immediately, a slightly different procedure called a cricothyroidotomy may be done. A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or emergency airway puncture) is an emergency incision through the skin and cricothyroid membrane to secure a patient's airway for emergency relief of upper airway obstruction. A cricothyrotomy is usually performed by paramedics and emergency physicians as a last resort in cases of severe choking due to upper airway obstruction when attempts at orotracheal and nasotracheal intubation have failed.
Preferably, when establishing an airway by a cricothyroidotomy (sometimes called a tracheotomy), percutaneous or non-dissection devices and techniques are normally preferably to dissection procedures, which require considerable more surgical skills in that many blood vessels are involved which tend to bleed profusely during a dissection procedure.
In this regard, combat casualty care, (that is, providing cricothyroidectomies in a field environment) continues to be a major challenge. Performing successful cricothyroidectomies has been identified as one of the three most important procedures for saving soldier's lives. Field cricothyroidectomies are critical to maintain life and provide severely injured far-forward battlefield participants an opportunity to survive until treated in a battlefield treatment facility. The current overall complication rate of a combat cricothyrotomy is 32% or 5 times higher than the complication rate when the procedure is conducted under controlled circumstances. Duress, adverse conditions, and non-standardization of airway kits all contribute to a high complication rate, including errors in incision location and incision depth in “combat care situations”.
In this regard, fast, efficient, reliable, and effective emergency tracheotomies in support of combat casualty care in various field environments are currently not available due to, among other things, (1) lack of adequate and safe lighting, (2) too-deep tissue incisions that open both the trachea and esophageal tissue, (3) lack of device or means to directly and immediately displace incised tissue (4) non-standardization of airway medical kits, i.e., a wide variety of products and components are randomly and individually collected and loosely assembled among a variety of tracheosotomy medical kits (each kit being unique to the individual who assembled the kit), and (5) lack of easy access to necessary kit components.
The diversity and disparity in medical equipment, lack commonality of procedure/techniques resulting from the use of that equipment, and diminution of needed rapid component access, all contribute to confusion and loss of critical, life-saving time in the execution of emergency cricothyroidectomies in the field.
A currently available airway device includes the Rusch QuickTrach sold by a number of on-line distributors. Other airway devices include those described in U.S. Pat. No. 4,520,810 issued Jun. 4, 1985 to Weiss; U.S. Pat. No. 4,677,978 issued Jul. 7, 1987 to Melker; U.S. Pat. No. 4,978,334 issued Dec. 18, 1990 to Toye et al.; and U.S. Pat. No. 5,217,005 issued Jun. 8, 1993 to Weinstein, and the common #11 surgical scalpel and well-known endotracheal breathing tube.
Although each of the aforementioned devices provide for an airway into the body, none of the devices provide the combination of features of the subject matter described herein. Accordingly, it is desirable to provide a method and apparatus having universal and common components and safer and more expedient methodology of execution in providing an airway in medical procedures including tracheostomies and cricothyroidectomies under all emergency medical circumstances and environments.